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Module 1 - Antepartum Care

Antepartum Before birth (prenatal)
Intrapartum During birth
Postpartum After birth
Gravida Any pregnancy, regardless of duration, also number of pregnancies, including the one in progress, if applicable;
Primagravida A woman who is pregnant for the first time
Nulligravida A woman who has never been pregnant
Multigravida A woman who has been pregnant before; regardless of duration
Para A woman who has given birth to one or more children who reached the age of viability (20 weeks) regardless of number of fetuses; indicates outcome of pregnancies
Primipara A woman who has given birth to her first child (past point of viability) regardless of whether or not the child was alive at birth or is now living
Multipara A woman who has given birth to two or more children (past the point of viability)
Nullipara A woman who has never given birth to a child who reached the point of viability
Abortion Termination of pregnancy before viability (20 weeks gestation) either spontaneous or induced
Gestational age Prenatal age of developing fetus as calculated from the first day of woman's LNMP
Fertilization age Prenatal age of developing fetus as calculated from date of conception: approximately 2 weeks less than gestational age
Age of viability A fetus that has reached the stage (20 weeks) where it is capable of living outside the uterus
What are the positive signs of pregnancy? Audible fetal heartbeat, fetal movement felt by examiner, and ultrasound visualization of fetus
How do you calculate Nagele's Rule Identify first day of LNMP, count backwards 3 months, add 7 days, and update year if applicable
When does the fetus heart start to pump blood/beat? 4 weeks
When does the embryo have a distinct human appearance? 8 weeks
When can the fetal heart tone be auscultated with a Doppler? 10 weeks
What chromosome does the sperm carry? X or Y
What chromosome does the ovum carry? X
What sex does XX result in? Female
What sex does XY result in? Male
When can the baby's gender be determined on ultrasound? 10th to 17th week
Where does fertilization take place? Outer third of the fallopian tube, near the ovary
What is the survival time of the sperm that is ejaculated near the cervix? Up to 5 days
How long prior to ovulation can intercourse lead to pregnancy? 5 days
What is considered the "life line to the fetus", also known as the organ for fetal respiration, nutrition, and excretion? Placenta
What four hormones does the placenta produce? Progesterone, estrogen, human chorionic gonadotropin (hCG), human placental lactogen (hPL)
How is the fetal deoxygenated blood and waste products leave the fetus through? Two umbilical arteries
How does the fetal oxygenated blood and nutrients return to the fetus? Umbilical vein
What can be transferred to the fetus through the placenta? Drugs, nicotine, & viral infectious agents (May cause fetal drug addiction, congenital anomalies, and fetal infection
What does Wharton's jelly do? Covers and cushions cord vessels
What is the normal length of the umbilical cord? 22 inches (55cm)
What is the easiest way to remember the number and type of umbilical cord vessels? AVA - 2 Arteries, 1 Vein
What are the functions of the amniotic fluid? Maintain an even fetal temperature, prevents fetal skin from adhering to amniotic sac, allows symmetrical growth, allows buoyancy & fetal movement, and acts as a cushion to protect fetus & cord from injury
Monozygotic Single fertilized ovum that divides (identical)
Dizygotic Two separate fertilized ovum (fraternal)
How does blood enter fetal body? Through umbilical vein
How does the blood circulate in the fetus? Half goes to the liver, remainder enters inferior vena cava through ductus venosus, then go through foamen ovale, then ductus arteriosus
What diverts most blood from right atrium directly to left atrium, rather than circulating to the lungs? Foramen ovale
What diverts most blood from pulmonary artery into aorta? Ductus arteriosus
What diverts some blood away from liver as it returns from placenta? Ductus venosus
When does the foramen close? Within 2 hours after birth (permanently by 3 months)
When does the ductus arteriosus close? Within 15 hours after birth (permanently by 3 weeks)
When does the ductus venosus close? When the cord is cut at birth (permanently by 1 week)
What may cause the reopening for the foramen ovale and the ductus arteriosus? Respiratory distress syndrome
What body system is affected by pregnancy? Every body system
What is supine hypotension syndrome? Also called vena cava syndrome, occurs when a woman lies flat on her back allowing heavy uterus to compress inferior vena cava, reduces blood flow to her heart, and can lead to fetal hypoxia
What are the symptoms of supine hypotension syndrome? Faintness, lightheadedness, dizziness, and agitation
What is the remedy for supine hypotension syndrome? Turning patient to one side (left), which relieves the pressure on the inferior vena cava
What happens to the uterus during pregnancy? Becomes temporary abdominal organ, and its capacity is 5000 mL (fetus, placenta, and amniotic fluid)
What happens to the cervix during pregnancy? Changes in color and consistency. Mucus plug formed to prevent ascent of organisms into uterus
What happens to the ovaries during pregnancy? Produce estrogen to maintain uterine lining during the first 6-7 weeks of gestation until the placenta can take over task
What happens to the vagina during pregnancy? Increased blood supply causes it to have bluish color, vaginal secretion increase, pH more acidic, higher glycogen levels which promote Candida albicans (yeast) growth
What happens to the breast during pregnancy? High levels of estrogen & progesterone prepare breast for lactation, "premilk" is expressed and is high in protein, fat-soluble vitamins, and minerals, low in calories, fats, and sugars
What is striae? Stretch marks
What is linea nigra? Dark line midline of abdomen
What are the postural changes in pregnancy? Low back aches, relaxation of pelvic joints, waddling gait, and change in center of gravity
What is beneficial during a normal pregnancy? Mild to moderate exercise
What can happen if mother takes OTC during pregnancy? Drugs can cross the placenta and have impact on fetal development, especially in the first trimester
What is normal weight gain? 25-35 lbs.
What is weight gain for underweight women? 28-40 lbs.
What is weight gain for overweight women? 11-25 lbs.
What is weight gain for multifetal pregnancy? 37-54 lbs.
What should the calorie increase be for pregnancy? 300 kCal per day
What foods are high in protein? Milk, eggs, cheese, meat, grains, nuts
What foods are high in calcium? Milk, yogurt, cheese, tofu, dark green leafy vegetables, dried fruits, canned salmon
What foods are high in iron? Liver, red meat, eggs, leafy vegetables, broccoli, dried fruits, fortified cereals
What foods are high in folic acid (Folate)? Green leafy veggies, oranges, artichokes, liver
What vitamin prevents neural tube defects Folic acid (Folate)
How is iron best absorbed? Between meals and when given with vitamin C
What interferes with absorption of iron? Milk and caffeine
What occurs at a prenatal visit? Complete history and physical; Identify problems that may affect the woman and developing fetus, ensure healthy pregnancy and delivery of healthy infant
What are the physical examination objectives? Evaluate woman's general health, determine baseline weight & vital signs, evaluate nutritional status identify current physical/social problems, and determine EDD
How often does a woman in her first & second trimester (conception to 28 weeks) see her doctor? Every 4 weeks
How often does a woman in her third trimester (29-36 weeks) see her doctor? Every 2 weeks
How often does a woman in her third trimester (36 weeks - delivery) see her doctor? Every week
What is a typical fetal heart rate? 110-160
What are routine assessments at each prenatal visit? Risk factors, vital signs & weight, U/A, blood glucose screening, fundal height, Leopold's maneuvers, fetal heart rate assessed with Doppler, nutrition intake, and any discomforts or problems since last visit
What is the purpose of ultrasonography? Determine gestational age, monitor fetal growth, see number of fetuses, estimate volume of amniotic fluid, note presence of anomalies
What is the purpose of maternal serum alpha-fetoprotein screening? Identify birth defects & anomalies such as down syndrome (low levels) and neural tube defects (high levels) such as spina bifida
What is the purpose of the amniocentesis late in pregnancy? Identify severity of maternal-fetal blood incompatibility and assess fetal lung maturity
What is the purpose of a kick count test? Maternal assessment of fetal movement
What is the most non-invasive way to verify gestational age? Measuring the height of fundus
What is the purpose of a non-stress test? Evaluate response of fetal heart rate to fetal movement, assess fetal oxygenation and placental function, performed when risk is present for placental insufficiency after 27th week to 30th week of pregnancy
What is the non-stress test procedure? Place client on side, reclining chair or semi-fowlers with wedge under hip
What are the parameters of a non-stress test? Recorded as "reactive" if FHR increases 15 beats for at least 15 seconds and occurs 2 or more times in 20 min. period. Non-reactive for negative results
What is the purpose of a contraction stress test/oxytocin challenge? Evaluates response of fetal heart rate to decreased oxygen supply during uterine contractions, via external fetal monitoring (ability to tolerate contractions) Performed after 32nd week of pregnancy by stimulation of uterine contractions
What is the contraction stress test procedure? IV infusion of small doses of oxytocin to monitor response of fetal stress, or manual stimulation of nipples to produce oxytocin release by pituitary
What are the parameters of contraction stress test? Positive (abnormal) if persistent & consistent late decels on more than half of contractions. Physician may induce / perform C-section. Negative (normal) within 10 min. period with three contractions and no late decelerations of FHR
What are common discomforts in pregnancy? Fatigue, nasal stuffiness, nausea, heartburn, constipation, hemorrhoids, vaginal discharge, back ache, varicose veins, leg cramps, edema of lower extremities
What is the best way to combat backache? Wear low heals
What is the best way to help with leg cramps? Dorsiflexion of foot and stand up while having cramp
What is the impact on the adolescent in pregnancy? Must cope with two of life's most stress-laden transitions at the same time; adolescence and parenthood
What must not be given during pregnancy due to risk of mercury poisoning? Thimerosal (preservative in vaccine)
How long must you avoid pregnancy after receiving MMR vaccine? At least 1 month
What are manifestations of hyperemesis gravidarum? Excessive nausea & vomiting, significant weight loss, dehydration, electrolyte & acid base imbalances, reduced delivery of blood, oxygen, and nutrients to fetus
What is the treatment for hyperemesis gravidarum? IV fluid to correct dehydration and electrolyte or acid-base imbalance, antiemetic drugs, small - high carb meals, and in extreme cases TPN may be required (hospitalization)
What are the causes of bleeding in the third trimester? Placenta previa and abruptio placenta
What is placenta previa? Abnormal implantation of placenta, may partially cover cervix. Painless vaginal bleeding of bright red blood
What is abruptio placenta? Premature separation of normally implanted placenta from uterine wall, occurs late in pregnancy, Vaginal bleeding is dark red blood, sharp abdominal pain, tender & rigid uterus
What is the nursing care of early pregnancy bleeding disorders? Document amount & character of bleeding, save anything that looks like clots or tissue for evaluation by pathologist, perineal pad count with estimated blood per pad, V/S, keep NPO, express regret for loss if woman aborts
What is an ectopic pregnancy? Pregnancy that implants somewhere other than within the uterus, 95% occur in fallopian tube
What are the manifestations of ectopic pregnancy? Lower abd. pain & may have light vaginal bleeding; if tube ruptures may have sudden severe lower abd. pain, vaginal bleeding, hypovolemic shock, and shoulder pain (referred pain)
What is the treatment for ectopic pregnancy? Pregnancy test, transvaginal ultrasound, laparscopic exam, priority is to control bleeding, three actions can be taken: no action, methotrexate to inhibit cell division, surgery to remove pregnancy from the tube; and grief counseling
What are the s/s of hypovolemic shock? FHR changes, rising/weak pulse (tachycardia), rising resp. rate (tachypnea), shallow; irregular respirations - air hunger, falling blood pressure (hypotension)
What is hydatidiform mole? Aka gestation trophoblastic disease or molar pregnancy. Occurs when chorionic villi abnormally increase and develop vesicles, may cause hemorrhage, more likely to occur in women at age extremes of reproductive life
What are the manifestations of hydatidiform mole? Bleeding, rapid uterine growth, failure to detect FHR, signs of hyperemesis gravidarum, unusually early development of GH, higher than expected levels of hCG, distinct snow storm in ultrasound
What is the treatment of hydatidiform mole? Uterine evacuation, dilation & evacuation, level of hCG is tested and retested until undetectable and followed for 1 year.
What does it mean if levels of hCG continue to rise after a hydatidiform mole? Suggest vesicles remain or malignant change has occured
What are predisposing factors of abruptio placenta? Hypertension, cocaine/alcohol use, smoking, blows to the abdomen, prior history of abruption of placenta, folate deficiency
What is the medical management of placenta previa? C-section, blood typed and cross matched available. Watch for infection after birth, post partum hemorrhage may occur, watch FHT
What is the medical management of abruptio placenta? C-section; hysterectomy may be necessary to control bleeding
What is gestational hypertension (GH)? BP > 140/90 in previously normotensive woman after 20 weeks gestation
What is preeclampsia? GH that has renal involvement (proteinuria) GH + proteinuria > 1+
What is severe preeclampsia? BP 160/110 or greater, proteinuria >3+, oliguria, elevated serum creatinine >1.2, cerebral or visual disturbances, and hyperflexia
What is eclampsia? Central nervous system involvement (convulsions); severe preeclampsia along with onset of seizure activity
What is chronic hypertension? Hypertension before 20 weeks gestation
What is treatment for hypertension? Activity restriction, rest periods, lying on left side, maternal assessment of fetal activity, BP monitoring, daily weights, checking urine for protein, drug therapy, antihypertensive's (Hydralazine, Labetalol, Nifedipine) *Magnesium sulfate given as IV
What are uses for magnesium sulfate? Anticonvulsant to prevent seizures, preeclampsia, preterm labor (inhibits uterine contractions which puts patient at increase risk for post partum hemorrhage because uterus doesn't contract)
What are signs of magnesium toxicity? Absence of patellar DTR's, U/O < 30 mL/hr., respirations less than 12/min., decreased LOC, and cardiac dysrhythmias
What reverses magnesium sulfate? Calcium gluconate
What are side effects of magnesium sulfate? Flushing and diaphoresis
How does Rh incompatibility occur? If the woman is Rh- and fetus is Rh+
When must Rhogam be given? 28 weeks & within 72 hrs of delivery, after amniocentesis, bleeding during pregnancy, and abortion
What is gestation diabetes? Glucose intolerance with onset during pregnancy
What are factors of gestational diabetes? Maternal obesity, macrosomic infant, maternal age older than 25 years, history of GDM in previous pregnancy, family history of DM, fasting glucose over 126 mg/dL or postmeal glucose over 200 mg/dL
What is treatment of GDM? Diet, may need insulin, monitor glucose levels, ketone monitoring, exercise, fetal assessment. **Oral hypoglycemic's are contraindicated
What is the care during labor for GDM patient? IV infusion of dextrose, regular insulin, assess blood glucose levels hourly and adjust insulin admin. accordingly
What is the care of the neonate who's mother had GDM? May have hypoglycemia, respiratory distress, injury R/T macosomia, blood glucose monitored closely for at least the first 24 hours after birth, breast feeding should be encouraged
What is TORCH? Acronym used to describe infections that can be devastating to the fetus or newborn
What are the effects on the fetus if the mother has rubella while pregnant? Microcephaly, mental retardation, congenital cataracts, deafness, cardiac effects, intrauterine growth restriction (IUGR)
What are preventive measures for toxoplasmosis? Cook meat thoroughly, wash hands and all kitchen surfaces after handling raw meat, avoid raw eggs & unpasteurized milk, wash fruits & veggies, avoid materials contaminated w/cat feces
What is the treatment for toxoplasmosis? Therapeutic abortion
What is toxoplasmosis? Parasite acquired by contact with cat feces or raw meat, transmitted through the placenta
What is Group B streptococcus (GBS)? Bacteria found in woman's rectum, vagina, cervix, throat, or skin
What is treatment for GBS? Penicillin
What are symptoms of GBS? Elevated temperature within 12 hours after delivery, rapid heart rate, abdominal distention (can be deadly to infant)
What are interventions for grieving parents? Allow parents to remain together in privacy, accept behaviors related to grieving, develop plan of care to provide support, offer a memento such as a footprint, let them hold infant, discuss wishes and concerning religious & cultural rituals
What are danger signs in pregnancy? Sudden gush of fluid from vagina, vaginal bleeding, abd. pain, persistent vomiting, epigastric pain, edema to face and hands, severe headache, blurred vision or dizziness, chills with fever over 100.4, dysuria, anuria
What herbs are contraindicated in pregnancy? Garlic, ginko biloba, St. Johns Wart, Chamomile, Ginseng
Created by: tandkhopkins